What makes a person want to have sex?

Sexual relationships are a normal part of healthy living. Three things lead to sexual activity: first there is desire -- wanting to have sex with a partner. When that feeling is strong, there is arousal -- the physical feeling that you "need" to have sex. Finally, there is orgasm -- the height of physical pleasure during intercourse. These processes depend on many reflexes that are coordinated by the nervous system, and involve hormones, nerves, and blood vessels.

How often should a person have sex?

The desire for sex varies widely in the general population and in people with epilepsy. A person who does not think about sex or want to have sex one to three times a month probably has unusually low sexual desire. But remember, this is a very personal matter, and if you are satisfied with your level of sexual activity, you have no problem.

Could my epilepsy cause problems when I'm sexually active?

We do not yet fully understand all the complex causes for sexual problems, especially how they may be related to epilepsy. For example, some people have a low level of sexual desire; others have difficulty becoming sexually aroused; or intercourse can be painful for some women. It is not unusual for people to have problems with sexual performance at times, and people with epilepsy are no exception. However, people with complex partial seizures, particularly when the seizures start in the temporal lobe, seem to have more sexual problems, such as the ones listed earlier.

I would like to have a close relationship, but I'm afraid to have sex. Is that unusual?

No. Low self-esteem or cosmetic effects from medication may make women and men with epilepsy feel sexually unattractive. Those feelings can lead to a lack of sexual desire and arousal. Acceptance of yourself and your epilepsy are important in developing an intimate relationship with another person. Perhaps you are afraid you might have a seizure during intercourse. Seizures often involve the same areas of the brain that are important to maintaining healthy sexual function, and some of the sensations felt during lovemaking can be similar to those experienced during auras or simple partial seizures.

I don't like sex because it hurts. What can I do?

Many women with epilepsy say that intercourse is painful for them. This is especially common in people who have temporal lobe epilepsy. Painful intercourse can be caused by dryness of the vagina or painful vaginal spasms during intercourse. Ask your physician about creams or gels for lubricating the vagina to ease the discomfort of intercourse. Gynecologists can do gradual dilations of the vaginal opening for women who have severe problems with pain and spasm.

Do men with epilepsy have sexual problems too?

Yes, almost a third of all men with epilepsy have difficulty achieving and maintaining an erection. Specialists called urologists offer help to men with sexual problems, including some medications that ease problems with erection.

Can seizures have anything to do with how I feel about sex?

Yes, they may. When seizures are under control, people seem to have improved sexual desire and performance. Any of the antiepileptic drugs (AEDs) can possibly cause sexual difficulties. However, this reaction to one medication does not mean you will have the same experience with another. Talk with your doctor about trying another anticonvulsant medication for your seizures if you suspect this is a part of your sexual problem.

Hormones play an important role in sexual function and some people with epilepsy have alterations in normal hormone levels. Both seizures and epilepsy medicine can interfere with the way your body uses hormones, resulting in sexual problems. You may need referral to an endocrine specialist to sort out the complex interactions between hormones, seizures, and medications.

I am embarrassed to talk to my doctor about sex.

It may be difficult, but it is very important to talk to your doctor about sexual difficulties. In addition to epilepsy, there are other causes for sexual dysfunction that can be diagnosed and treated (medical conditions such as diabetes, thyroid disorders, or high blood pressure). Your physician may ask questions about religious beliefs, uncomfortable experiences in your past related to sex, any stress or recent illness, and details of your sexual relationships. These are private, personal issues, but it is important to share the information openly, to help your doctor understand your problems and provide the appropriate help in solving them.

I've heard about sex therapy. Would that help?

Talking about your sexual difficulties with a trained therapist can be very helpful. Sometimes, anxiety or depression is causing problems with sex. It is often important to bring your partner for couples therapy. Some people need information about sexual feelings and activities and suggestions for making their relationship more pleasurable.